Monica Bertagnolli, President at National Academy of Medicine, shared a post on LinkedIn:
“Scott Atlas wants to abolish the National Institutes of Health and let markets take over (‘NIH is a government weapon for political power. Abolish it,’ Washington Post, July 2). He reaches back to Milton Friedman’s 1980 quip that the NIH should be replaced with ‘nothing’ as though nearly half a century of biomedical history since then simply didn’t happen. It did. And the record it left is not an argument for demolition. It is in fact one of the strongest arguments in American public policy for continued, and better, public investment.
An engine, not a ‘weapon’
Start with the plainest fact Atlas omits: almost every drug in your medicine cabinet exists because NIH-funded basic science mapped the biology that made it possible. Pharmaceutical companies are extraordinarily good at the last, expensive mile — clinical trials, formulation, manufacturing, marketing. They are not in the business of funding the fifteen-year, high-failure-rate hunt for how a protein misfolds or a virus enters a cell, because that kind of research doesn’t fit a quarterly earnings report. That’s not a market failure Atlas can wish away with a check to venture capital; it’s the reason NIH exists. Cell-based immunotherapies, mRNA platforms to treat autoimmune diseases, infectious disease, cancer, and genetic disorders, GLP-1 drugs now reshaping obesity and cardiovascular medicine, the entire architecture of modern genomics — all trace back to NIH-funded basic research that no drug company would have bankrolled on its own, because none of it looked profitable at the time.
The economic case is just as obvious. Two decades ago, a bipartisan group of Congresspeople asked the National Academies to identify the most important actions policymakers could take to remain globally competitive in the 21st century (Rising Above the Gathering Storm). At the top of the list: double the federal investment in research.
Here’s how federal biomedical research fuels our economy. NIH funding doesn’t crowd out private investment — it de-risks early science so private capital can follow it. Independent analysis of NIH’s footprint has found that every dollar of NIH funding generates over two-and-a-half dollars in new economic activity, and that NIH investments have supported hundreds of billions of dollars in economic output and hundreds of thousands of American jobs per year, concentrated not in Washington but in university towns and biotech clusters in every state. Calling that a ‘government monopoly’ gets the economics wrong. Kill the NIH and you don’t get a thriving free market in biomedical research. You get instead American venture capital playing catchup, chasing the safer, later-stage bets that other countries’ publicly funded science has already de-risked for them.
Peer review is not the enemy of innovation — it’s the reason we trust the results
Atlas’s deeper target is not just NIH funding, but also peer review — the system of expert assessment that determines which studies the NIH funds. Atlas casts peer review as a groupthink cartel protecting insiders. This gets the incentives exactly backward. NIH’s dual-level peer review, where expert study sections score scientific merit, followed by council review, exists precisely to prevent political appointees, favored institutions, or fashionable hypotheses from dictating what gets studied. Is it perfect? No. Reviewers are human, reputational bias creeps in, and NIH itself has spent years reforming the system, including a 2025 shift to simplified review criteria specifically designed to reduce the influence of institutional pedigree and let ideas compete on their merits. That is what a functioning system does: it opens itself to scrutiny, identifies its own flaws, and corrects them in the open.
The alternative Atlas encourages — replacing independent expert review with market signals or political appointees deciding what counts as worthy science — isn’t reform. It’s the actual politicization and opacity he claims to be fighting, just administered by different people. If you think NIH grants are sometimes too conservative, too slow, or too safe, the answer is to keep pushing review criteria to reward genuine risk-taking, shorten timelines, and expand opportunities, not to hand the entire portfolio to whoever holds the White House this term or to investors and companies who need to demonstrate results by the next fiscal quarter.
The workforce no one else is building
There’s a piece of NIH’s mission Atlas never mentions, because it doesn’t fit his story: NIH doesn’t just fund experiments, it funds people. Training grants, fellowships, career development programs, and research project grants that carry graduate students and postdocs through their formative years exist because no pharmaceutical company is going to pay to train the next generation of scientists who might end up working for a competitor, for a university, or for a biotech startup. This is textbook public-goods economics: workforce training with enormous social returns and diffuse benefits that no single private company can capture, so no single private company will pay for it.
Abolish NIH and you don’t just lose grants; you sever the pipeline that produces outstanding American biomedical scientists. This damage would not show up immediately; it would unfold over years as promising young researchers leave the field, laboratories contract, clinical research programs close, and the United States becomes less able to take advantage of the next technological breakthrough or respond to the next pandemic, antimicrobial resistance crisis, or bioterrorism threat.
Yes, NIH should keep changing
None of this means NIH is beyond criticism. The agency has real problems: sclerotic administrative burdens on investigators, a grant-review cycle that can be too slow for fast-moving fields, funding concentrated heavily among a small number of elite institutions and senior investigators, and a review system that can be too risk-averse. The disruption of the past three years — centralizing peer review, unwinding rigid paylines, cutting administrative overhead — has sometimes been chaotic and has understandably frightened a research community that depends on stability to plan multi-year projects.
But chaos and opportunity aren’t mutually exclusive. This moment is a real chance to make NIH leaner and more nimble: faster review timelines, funding formulas that don’t systematically favor already-wealthy institutions, better support for early-career and geographically diverse investigators, and continued vigilance against letting political fashion — from any administration — substitute for scientific merit.
One issue squarely belongs in the NIH reform conversation: indirect costs. These reimbursements cover real, unavoidable expenses, such as laboratory space, equipment, utilities, IT infrastructure, regulatory compliance, and the administrative staff who keep federally funded research legal and safe. They are not padding to be waved away. But how those rates are calculated, negotiated, and capped is a legitimate and separate policy question that deserves rigorous, transparent debate on its own terms rather than being used as a rhetorical cudgel in the broader case for abolishing NIH’s research mission entirely.
The choice is reform or retreat
The United States became the world leader in biomedical science because it built a research ecosystem that no single sector could have created alone. Government funds foundational discovery, translational research, and training. Universities and medical centers provide expertise, infrastructure, and scientific communities. Industry turns knowledge into products that reach patients. Philanthropy fills gaps and often takes risks in areas that need additional support. Each sector plays a crucial role in advancing US innovation and improving health.
The ecosystem is not flawless, but it has produced extraordinary returns for health, the economy, national security, and American competitiveness. Abolishing NIH would not be a blow against bureaucracy. It would be a retreat from the public investment that made American biomedical leadership possible in the first place.
Reform NIH aggressively. Demand more from it. Make it faster, bolder, fairer, more transparent, and more accountable. But the answer to an imperfect engine of American scientific leadership is to tune it, not to set it on fire and hope the market rebuilds it from scratch. It won’t. It never has.
